MEDICARE: MRS. KRISTINA LYNN IGWEIKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		VA

General Provider Information

NPI Number	:	1841780988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA LYNN IGWEIKE

Provider Business Mailing Address
First Line	:	2314 FAIRFIELD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-4124
Country	:	US
Telephone Number	:	804-918-5474
Fax Number	:	804-716-7261

Provider Business Practice Location Address
First Line	:	2314 FAIRFIELD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-4124
Country	:	US
Telephone Number	:	804-918-5474
Fax Number	:	804-716-7261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/15/2018

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